Friday, June 24, 2016

Horrible headlines/ How to talk to your kids/ What would you do if?



Last week, civilized caring people everywhere were horrified with the senseless shootings in Orlando. If that wasn’t enough, the bizarre death of the toddler by a crocodile made any person watching the news want to curl up and weep. It is all too frequent that we turn on the TV to find out about sad and scary events. Several parents have asked me to write a blog addressing how to talk about these incidents with our children.

Obviously the first step is to protect them from the media as much as you can, but even if they are not watching TV, if parents are devastated by an incident, your kids may well pick up on the fact that something is “not right.” Talking about things out in the open makes future conversation possible and keeps things from feeling like a bad secret that needs to be avoided at all cost. Unfortunately simply avoiding tough conversations won’t make the issue go away. You may decide to ask your kids if they heard that something sad or bad had happened. Allow them to tell you what they have heard or seen. I wish I had the perfect way to make sense of the inexplicable evil. I have to believe that there is more good than bad; the bad folks just make so much noise.

We need to feel like we have some tools for dealing with emergencies if they happen closer to home. I am rerunning my problem solving post (one of my favorites) but I have added some new thoughts at the bottom.

What  would you do if?
I have been doing these little weekly emails for just about 3 years now. Some posts are clearly more relevant to parents with young children while others are much more applicable to older children. Some are more global and your child's age doesn't matter so much. This is the latter.
Today's topic is a about an important activity that you can do with your child that teaches them to be "problem solvers".

Although at first glance it may seem targeted to parents with older children, in fact everyone could learn from it. Adults need to learn to be problem solvers also. Some are much better at this than others. For instance, if you got in a fender bender, what would you do? Many folks would just freeze and panic. What should you do?

*Assess for injury;  call 911 if needed
*If you are on a highway, wait for assistance. Getting out of the car might be more dangerous
*Know where your insurance info is
*Take a photo of any damage
*Take a photo of the other driver's insurance card and driver's license...etc.
*Always have a charger in your car for your cell phone so that a low battery is never an issue.
But I do I want to add one more benign  tidbit here. What if you lost your cell phone or it ran out of batteries and you don't happen to have a charger? Do you know important phone numbers, or do you count on speed dial? Having a list of important numbers in an accessible place is a good idea for everyone.

Having a plan in advance could help you stay calm.
Years ago, the concept that everyone would carry around an individual cell phone seemed as futuristic as the communicators on Star Trek. Now, of course it is hard to imagine how we got along without them. It was, however, the lack of the cell phone that prompted me to create a game that became a favorite in our family.
It must have been 1994 and I was on my way to pick up Alana from preschool. She was about 4 years old at the time. It was one of those days. I was uncharacteristically running late. Then, I got stuck in terrible traffic. To compound things, I took some random turns to try to work around the congestion and ended up utterly lost. (Remember that this was also before Google maps or GPS.)  My stomach was in a knot and I wondered what my younger daughter would do when mommy was late picking her up.

It turned out that she was calmly waiting for me in the office, but that was the day that the "what would you do if" game was created.
It went something like this:
I would ask a question such as, "What should you do if mommy is late picking you up? What are some of the choices? Which is the best one?"
Getting a teacher or trusted grown up to wait with her or take her to the office was clearly the right answer and I praised her for figuring that out on her own.
Alana loved this game. We created all sorts of situations
" What if we were at a store and you couldn't find me?
Alana.." I would go to the check out and ask them to page you"
We never made it too simple...
Mommy :"What if they refused?"
Alana :"I would demand to talk to the manager"
Our scenarios covered any number of little emergencies including earthquakes, fires, and getting lost or separated. The better you are at problem solving, the easier it gets to improvise.

This game came in handy more than once. The shining example that comes to mind happened after years of playing this game. Alana and I were walking the dog on the beach one day. I had donated blood earlier that morning and didn't realize how foolish I was for doing anything strenuous. I got very light headed and ended up down on the sand trying hard not to completely pass out. Alana was ten at the time and she went right into problem solving mode. We did have cell phones at this point. She got the dog on the leash, patted some water on my forehead and calmly called daddy. I could vaguely hear her talking. "Mommy fainted...I think she is okay."
The game was such a success that my sister taught it to her kids. Hers had an interesting spin because they lived in Alaska at the time:
"What would you do if you saw a bear?"
"What would you do if a moose wanders into the yard?"
There were actually times when these things happened, and my nephews were able to act calmly and appropriately!
Topics can range from handling a bully to getting separated on Muni. Being prepared for unexpected situations can be invaluable.
 If your child finds themselves without you and in need of assistance, finding a grown up wearing a uniform is often a valid option for some of the difficult situations. Finding a parent who has a child with them and asking them for help, might be another safe option.
This game is meant to empower. It is wonderful for some kids, but could be terrifying for others. You need to assess your child's temperament before playing. Either way, identify a problem or situation. Start with simple, less scary ones. Discuss all the possible solutions and then agree what the best plan should be for any given situation.
Stressful situations happen. Teaching your child to take a deep breath and use their problem solving skills is one of those things you can do now that can have lasting implications for them when they grow up.
Even teaching a very young child to dial 911 in an emergency can be life saving!
You have to figure out if this will be empowering for your child as it was for Alana. My daughter Lauren never liked to play it. In fact, I remember one day when Lauren and I were taking a walk, I tripped on something, stumbled and fell. I was perfectly fine, but Lauren's reaction was to start screaming. I think she was ten at the time. As she says, "mommies aren't allowed to fall". Every kid is different. As your child grows, the situations that you might want to bring up will increase in scope.
Preparation is power.
It saddens me we have to be prepared for things other than losing track of our kids on Muni, but that is the world we live in.
Have a family plan in place in case of emergency.   If someone other than one of the regular people is going to pick up your child, have a family “safe word” so that they know they were sent by you.
Do you have your earthquake/emergency kit ready? Does it include adequate diapers, medications, pet food? Where will everyone meet up if home is not a safe option? Find out from your schools what kind of emergency plans they have in place.
Teach your kids to get in the habit of looking for emergency exits, especially for your olds kids who are at a concert, theater or a club.
I think that the "what would you do" exercise is actually something that you might want to do with a nanny or caretaker. Training to keep calm in any type of emergency situation is essential.
If there is a crisis or loss that is closer to home
Kidspower is another fabulous resource. I reached out to the director Irene, and she shared the following valuable links.
Helping Children Regain Their Emotional Safety After a Tragedy
Tragic Shootings: How Can We Protect Our Loved Ones and Ourselves From Violent Attacks?
Safety Comes From Inside Ourselves: Protecting Emotional Safety After A Terrorist Attack
Fears about School Shootings and Lockdown Drills – Kidpower Recommendations and Resources

Friday, June 17, 2016

A Father's Day post from "Mr" Nurse Judy

Happy father’s day!

In honor of father’s day, Nurse Judy has invited me pen this week’s column and share some of my thoughts about why I have, and you the dad can have, the absolutely greatest relationship with your kids through all stages of their lives. I believe that inherently, mothers are more nurturing, protective, overtly emotional, physical, and “maternal” in their instincts, beliefs and behaviors towards their children. But from the moment I first saw Lauren, a day that all who know me recognize as the most impactful day of my life, I knew I was going to give Nurse Judy a run for the money. I, like many of my generation, had an ok relationship with my parents. But it was not the one I wanted with my kids, and that became immediately obvious that day Lauren was born.

I have been called a lot of things over the years. I am frequently referred to as Mr. Nurse Judy. After years of taking our golden retriever to the park up the hill in the afternoon when the local elementary school let out, I became known to a few generations of kindergarteners and first graders as Java’s daddy. I was known as a business executive. But the grandest name I treasure is that of daddy (or father or papa bear or…)  Why? Because after building a relationship with Lauren for 28 years, and with Alana for 25 years, I continue to have new and grand experiences with them, experiences that are direct descendants of the beliefs I had in raising them. And now I have a daughter who jumped at the opportunity to go on a daddy/daughter cross country road trip when she left for grad school, where we got to eat yellow (yes, there’s a story there) in Indiana, and simply cross a bridge into Kansas, make a U-turn, leave and say “we’re not in Kansas anymore.” And I have a daughter who is still my roller coaster buddy every August, and is accompanying me on what may be the stupidest thing I ever try – climbing Kilimanjaro. So how did I get here?

First of my early parenting philosophies was simply make time. I’m not talking about the “I’ll play with you when I get home and I’ll read you a bedtime book” type of time.  I’m talking about the “take a morning off to hear your 2nd grader say one line in a play; use vacation days to chaperone school outings; play Barbie for hours on end; and supervise a cabin full of 5th grade boys on the school trip” kind of time. A typical dad probably spends more time away from their child than the mom. So take advantage of the time that you can have!  As soon as my kids came home from the hospital, I never missed an opportunity to be with them. Each night, when an infant would wake up and cry, I went in. It was pickup and delivery to Judy to nurse them.  Judy thinks I was doing this for her but she was just a benefactor. I picked them up, sang softly or told stories to them as I cleaned them up, and then brought them to our room. And then back to their cribs. Every night. We built up quite the relationship. Bath time? That was mine too. Nightly bedtime ritual? Well we both had one. But much of my daughters’ love for the great rock and roll of my youth comes from that time we spent every night.  As they became toddlers, every weekend I took them to Miz Brown’s diner in Laurel Village. So Judy could get more sleep? Hmm, ok, but not really. It was completely selfish on my part. Want more time? Be the home that welcomes the gathering of the friends. While perhaps not directly involved in your child’s life at that moment, the benefits are extraordinary in what you get to witness, the welcoming environment you’re modeling for your kids, and the lifetime of relationships with your childrens’ friends, who consider you an extra dad.

Next on my list of dad-parenting beliefs is “don’t look for a reason to say yes; assume that’s the answer, and instead force yourself to look for a reason to say no.” It’s simple but at least for me, it was initially uncomfortable and unnatural. But once I grew comfortable with this practice, it was an epiphany! Saying yes to as much as you can say yes to, is so much easier than saying no. And it has such wonderful benefits. Questioning, exploring, learning, experiencing…and you get to be a cool dad! Talking about going on a family camping trip when you’re asked if they can try camping in the house? Say yes, and set up the tent in the living room, light the fire, roast marshmallows, and sleep in sleeping bags. We can all think of valid reasons not to do this and I’m certain my instinctual reaction was “too much time; too much effort, and then I have to clean it all up and put it away.” But saying no wasn’t going to lead to the magnificent shared family memory we now have 20+ years later, and I certainly don’t remember anything about setting it all up or taking it down.  “Dad, can I help?” Of course there are reasons to say no; it will certainly take more time. And you may have to watch your language. Unless it’s urgent, so what? Invite your 3-year-old to crawl under the car with you. Rub some dirt on their nose to make it official! And let them help! “Can I go someplace?”; “can someone sleep over?” Yes. And yes. Unless something is a threat to their health and well-being, be quick with the yes! Might some of these yeses have less than ideal implications to you and your free time? Probably, but that’s not what you’re going to remember!  Only after saying yes can you then figure out if there is a “no” reason significant enough to change your mind. The more you say yes, the more they will ask you. As school children. As teenagers. And now as adults.

You will recognize my last pearl of wisdom as a modification of the Peter Pan syndrome. Let them be kids as long as possible!  While it may be cliché, as we all know and live every day, once that’s gone, it’s gone forever, and I know that I, and maybe you, wish you could get it back! So don’t take it away from them. Don’t be in such a hurry to “help” them see things as you see them, through adult eyes and perceptions. They are emotionally, physically, and intellectually naïve – it's a wonderful time so don’t rush to take that away from them. In fact, for a truly wonderful relationship, force yourself to see the world as they do! That’s why I once found a pet/fish store open till midnight so I could go out and replace the fish that had died when Lauren was asleep (and yes, I brought the dead fish with me to try to get a match!) Of course she would have to learn to deal with the death of a beloved pet, and eventually beloved humans. But she didn’t have to learn about it that day, and it let her be a kid a little bit longer. 

Don’t try to explain why work is so busy, that you need to do it to pay the bills that benefit them, and thus you don’t have time to play Chutes and Ladders for the 5th time in the past 2 hours. Instead, see it through their filters – why would anyone want to deal with things that are drudgery and frustrating when you can have fun playing a grand game? They didn’t ask to be your child – you decided to make them your child. I hope that decision was made with an appreciation for the fact that this responsibility instantly became the single greatest responsibility you have ever undertaken. The consequences of that decision are literally life changing for all involved. If it’s not your greatest responsibility, then something’s awry and you will miss out on immeasurable joy.

In the summer of 1988, my family of 3 (Lauren was 1) was invited to a swimming party at the home of my then senior VP. He had 4 adult daughters. While everyone was subtly vying for his attention, I spent the greater part of the day with Lauren in the pool. Late in the afternoon, the VP’s wife found me and pulled me aside to tell me that her husband had spent much of the day watching us play in the pool. Why? As she explained, he had been the wonderful corporate soldier. Moved all around the country when he was asked to. Frequently travelling. Successfully moved up to senior VP of one of the world’s largest companies. And she told me that if he had to do it all again, he would rather have spent the time in the pool with his daughters, because now he was here, envying me and the relationship I was already building with my child. Over the course of my career, I was often asked to make those same sacrifices, but by then I had already learned my golden rule – I worked to live; not lived to work. And while I had a satisfying and rewarding career, I never reached for those corporate stars that were dangled in front of me. Because one day I was hoping that I would have the type of relationship with my children that allows me to eat yellow with one of them, and climb a mountain with the other.

Thursday, June 9, 2016

Motion Sickness (Update)

It is not unusual for us to get calls from folks who have a child or family member that suffers from motion sickness.  Females are more likely affected than males. People who suffer from migraines tend to be especially susceptible. While the majority of people who have the most issues with this are between 2-12, some younger babies seem to have trouble as well. We have some unfortunate moms who have babies that vomit every time they go out in the car.

If you know in advance that motion sickness is an issue, here are a few natural remedies that you may want to try. If you are someone who deals with this a lot, you will have plenty of car rides ahead to do your experiments and see what works for you.

Getting fresh air by having a window open is the first course of action. Do some distraction by playing a game that has your child looking out the window. I SPY is a good one. See if you can find interesting license plates or different colors or letters on signs. Don't sabotage your trip by bringing along trip activities that have your child focusing on things inside the car. Even the best passengers might be fine until they start reading or looking at a phone or map.

Most kids do best when their tummies are not too full or too empty. Little crackers to snack on might be useful.

There are wristbands that provide pressure to some acupressure points that seem to give relief. You can find these on Amazon. There are several brands. A popular one is called sea-bands. They come in multiple sizes and colors. Otherwise simply massage the wrist and lower arm area. The magic spot is located on the inner arm about 1.5 inches above the crease of the wrist, between the two tendons there.

Ginger seems to be very helpful. For older kids, there is a ginger gum specifically made for nausea (also available on Amazon). Find your favorite ginger cookie or candy. Trader Joe's has a wide assortment. Of course don't give anything to a young child that might be a choking hazard. Check out ginger lollipops (often marketed towards pregnant women.)

Motion Eaze is a topical aromatherapy that some folks swear by. You just dab a drop behind the ears and it provides relief within a few moments. Don't do this one for the first time before you embark on a long car ride. The smell is fairly pungent and other folks in the car might have a hard time with it. If you prefer not to apply a scent directly, there are several essential oils that have been found to help with nausea. Peppermint, spearmint, ginger and lemon are all on the list. Consider letting your child chose the favorite scent. You can apply a few drops to a cotton ball and put it in a baggy. The kids can take sniffs whenever they feel the need.

Hylands and Boiron both  make a homeopathic motion sickness remedy. As with many homeopathic remedies they gets mixed reviews. Homeopathy does seem to be the ticket for some folks, and is unlikely to cause trouble as long as it is used as directed. It might be worth a try. My husband likes to cry "placebo"
I say, "Bring it on, whatever works!"

If you are going on a long car ride, plane ride or boat trip and you have struck out with the natural remedies there are some medication options. Benedryl  is an antihistamine that often works quite well for motion sickness. It comes as a liquid. The bottle says for children over the age of 6, but in our office we do use it for younger kids. The dose usually agrees with the tylenol dose volume. Kids over 22 pounds would get 5 ml or one teaspoon. Always check with your own doctor's office to see what their policy is. Benedryl makes most kids sleepy, but don't count on that. It gets some kids hyper. You probably don't want to find that out on a cross country flight.

Dramamine is another choice. It is an over the counter medication specific for motion sickness. Children 2-6 years of age can take ½-1 tab; children 6-12 years of age can take 1-2 tabs. These chewable tablets can be repeated every 6 hours, no more than 3 doses in a 24 hour period. Start with the smaller dose first to see if it works. Giving the dose 30-60 minutes before travel is recommended. For kids over 6, Bonine is another reasonable choice. This medication can be given at the first sign of nausea and is less sedating.

For patients over the age of 12, if all else has failed some people use a scopolamine patch. This is a much stronger prescription medication that I would never use as a first line drug. Some of my motion sensitive older patients have found these valuable for cruises.

Luckily, kids do tend to grow out of it...except for an unfortunate few. If you or your child have chronic motion sickness issues, it can be eye related. Cover one eye for several moments to see if the symptoms ease. If this works, you may have something called vertical heterophoria (which I will be addressing in one of my upcoming posts) it is worth having a consult with an eye doctor. My favorite eye expert in this is Dr. Vincent Penza

Some people with chronic motion sickness have also gotten relief from chiropractic treatment.

For automobile trips, babies should stay rear facing as long as possible, BUT in rare and extreme cases if your child vomits every time they are in the car, and none of the above remedies have worked, I would try to turn them around and see if facing forward makes a difference. It isn't ideal, but having a vomiting child has it's own safety issues.

For the older kids, have them try very hard to give you as much warning as they can. Ideally they should try to get in the habit of warning the driver at the first twinge. The initial signs are usually paleness, yawning and restlessness. They may feel a little sweaty. This is quickly followed by the nausea and vomiting. With enough warning you might have time to pull over and get them out of the car for a couple of moments until the motion sickness eases. Being stoic is not a good plan; it usually backfires.

In my car, I actually kept barf bags in the glove compartment. When you fly, assuming yours remains unused, take it home with you.They may come in handy. If you don't have an actual barf bag, have a container or plastic bag that you can whisk out at a moment's notice.

Your trunk should be prepared:

A change of clothes (don’t forget socks)
A clean towel
A plastic bag for putting the soiled clothes in
Some wet wipes
A lollipop to get the yucky taste away
Febreze for cleaning off the seats (you will bless me)

While kids are usually the ones most apt to barf  in your car, motion sickness can afflict any of us at different times. I hope that some of these tips can help you out.

Thursday, June 2, 2016

ear infections/updated post

Please see updated post April 2019

As an advice nurse at a busy pediatricians office, talking about ear infections (medical lingo otitis) is among one of the more frequent calls I deal with. I feel a pang for the stressed out, busy parent who would love to throw some magic medicine at the issue without an office visit.  I know it is hard to take off time from work. Alas, it isn’t so simple.

Ear infections come in different varieties and complexities. Not only is there is not one standard treatment, but many times no treatment is even needed. Some stoic kids don’t make a noise about a severe infection while others complain bitterly about a little fluid in the ear that is not actually infected. If we blindly treated every complaint about an ear ache, we would be wildly over prescribing antibiotics. A special instrument that looks in the ear is often needed to make a true diagnosis. Factors like lots of ear wax, or an uncooperative patient can add a level of complexity to the exam.

The most common ear issues that we see are:

Otitis media (a middle ear infection)
Severe cases are treated with antibiotics

Serous Otitis (fluid  behind the eardrum)
This may be treated with decongestants or in chronic cases with ear tubes

Otitis externa (also known as swimmer's ear)
With otitis externa the outside of the ear is usually red and sore. The ears may be tender and will look inflamed. With summer coming, I usually see an increase in these cases, with more kids being in water or pools.

While the first two forms of otitis require a tool for diagnosis, otitis externa may be visible by just looking with the naked eye. This condition may  be treated with ear drops rather than oral medications, depending on the severity.

Some kids make it obvious. If they are old enough, they may simply  tell you that their ear hurts.  If they are still young and non verbal, they may be extra fussy (especially when put down,) feverish, or tugging at their ear. Many kids wake up more than usual at night. Most of the time kids are congested. Sometimes vomiting can be associated with ear infections.

Some kids seem like their balance is off. Others seem like they are having trouble hearing (I know I know, all of our kids can seem deaf when we are telling them something they don’t care to hear!)

A good number of  kids don’t let you know at all. We have had patients in the office for a well child exam and have been caught by surprise when a routine ear check revealed a raging infection.  I have also seen ear infections go from ‘zero to sixty’ in no time flat. A child with a perfectly normal ear exam one day can have a horrible ear infection the next.

Most of the time, an  infection in the middle ear  accompanies a common cold, the flu, or other types of respiratory infections. This is because the middle ear is connected to the upper respiratory tract by a tiny channel known as the eustachian tube. Germs that are growing in the nose or sinus cavities can climb up the eustachian tube and enter the middle ear. Children’s eustachian tubes are smaller and more level than those of an adult. This means it is harder for them to drain well and easier to get blocked up even with mild swelling. Because of these drainage issues, when kids are congested, they also may have fluid in their ear (serous otitis). This is why I am more suspicious about a possible ear infection in a child who has a cold. What may start out as a virus can turn into something bacterial. That fluid is the perfect medium for bacteria to grow. I compare it to a stagnant pond just waiting for the mosquitoes to breed.

Kids with chronic serous otitis who get one infection after another will usually end up at the ENT doc who may put some tubes in the ear to help them drain. Melissa Wilson, Doctor of Audiology at Sound Speech and Hearing, adds that tubes are also put in to address the hearing loss that often accompanies middle ear fluid. Fluid build-up often causes a hearing loss on the order of 30-40 decibels. Average speech is about 60 decibels, so having fluid is like listening with your fingers plugging up your ears. Everything your child hears is muffled and over time, this can impact their speech and language development, and for the school-aged children this can cause issues with listening in the classroom and academics.

An important thing to note is that  when kids have goopy eyes, many times they also have an otitis, which is why we may bring them in to check out the eyes and the ears rather than just giving eye drops over the phone. Just because your child is tugging at their ear does not mean they have an infection. Some kids do it as a habit when they are tired, Others do it when they are teething (especially upper teeth.) It can be a clue that is worth paying attention to, especially if it accompanies any other symptoms.
I realized after the fact that I had ignored my daughter Lauren’s first ear infection for more than a week when she was fairly young. Looking back at videos you can see the poor kid simply grabbing at her ear constantly. This was a long time ago, prior to my Noe Valley Pediatrics job, when I was working at UCSF with complicated surgical cases and thoughts of an ear infection didn’t even cross my mind.

If your child is diagnosed with an ear infection, chances are you will get a prescription for antibiotics. No one likes to overuse antibiotics, but If your child is miserable and feverish, I would  follow through with the treatment. If the eardrum is bulging and looks like the membrane may rupture, the doctor will advise you that you should absolutely go ahead with the medication regardless of how your child is acting. On the other hand, If it is not a severe infection and your child seems consolable, in our office we may suggest that it is perfectly fine to watch and see for a few days. Many ear infections can indeed clear up on their own and of course we all would like to avoid the use of antibiotics if we can. My main agenda, aside from making the kids more comfortable, is preventing an eardrum from rupturing. This does happen and we can’t always stop it but we avoid it when we can. An eardrum that ruptures frequently can become scarred and this can lead to hearing loss.

A miserable screaming child might actually seem more comfortable after the eardrum finally ruptures. They will also likely have lots of yellow/orange stuff draining out of the ear. The good news is that the pain of the pressure in there is gone, but the tympanic membrane (an important protective barrier) is no longer intact. Therefore, if your child does have a ruptured membrane, they need to be seen and treated even though they are no longer quite as fussy. After a rupture (certainly if there is more than one)  it is worthwhile getting the hearing tested to make sure there is no lingering hearing loss after the eardrum heals.

If the treatment plan includes a course of antibiotics, make sure that you finish the entire course of medication. I also suggest using probiotics to protect the gut. Do not give them exactly in conjunction with the antibiotics, rather try to space them in between doses. Also please don’t forget to brush those teeth. Liquid antibiotics tend to be sticky and sweetened in order to make them more palatable.

Some pharmacies can add flavors that might help with compliance. The magic folks at the 450 Sutter pharmacy here in SF can compound some antibiotics into the form of savory  crackers which have been a big hit. If you are having trouble getting the “medicine to go down” My previous blog post offers some tips.
It may take the medication at least a couple of days before you notice a significant improvement.  If your child is still super fussy or feverish after a full three days, have your doctor take another look in there to make sure the meds are working. Some kids who are having a really difficult time may end up getting an antibiotic injection. These hurt a bit, but they are usually quite effective.

With or without the use of antibiotics there are several things you can do to ease the discomfort of a painful ear. Tylenol and/ or Ibuprofen are useful. There are some prescription ear drops that can numb the ear, but they have some possible negative side effects, so most doctors no longer prescribe them. Warmth usually feels good. Try a warm wet washcloth against the ear. You also can put some rice in a sock or pour water into a clean diaper, heat either of those up in a microwave for an quick heat pad that will stay warm for a while (heat in 30 second increments to make sure they don’t get too hot.) Some folks swear by a warm hair dryer held about a foot away from the ear. Believe it or not though, my favorite remedy is garlic oil. Check the ear to make sure there is no reason to suspect a rupture.I don’t like to add any drops if I have any suspicion that the eardrum may not be intact.  If there is no odor or drainage (a little wax doesn’t count) garlic oil may be  a good option. Saute some cloves of garlic in some olive oil. Let the oil cool until it is warm/not hot. Take a cosmetic square (these are the round or square cotton pads that often come in a stack. I like them better than cotton balls for this.) Dip one half of the pad into the oil, roll it up like a scroll and stick it in the ear. Do this as often as your child will allow. If it is the middle of the night and your child is screaming, you can try any of these pain relief options until you have an opportunity to have your child checked. Persistent unrelenting misery may warrant a trip to the ER.

For any interested parents, there is a product on the market called a cellscope that allows you to visualize your child's eardrum  on your cell phone. Check out CellScope:

The Promo code NURSEJUDYNVP will get you 15% off your purchase
(For the record, I do not receive any compensation from CellScope; I just love helping families get a good deal!)
Keep in mind that looking at the ears is only one factor. If your child is ill, an office visit might still be indicated, , but if your child is someone who gets plenty of ear infections it can be incredibly useful.

Just last week a parent with a CellScope looked in their little one's ear and found a little piece of a cereal puff.
I told them that it’s better than the spider in a patient’s ear (honest to goodness) that one of our docs was surprised by last month!